When of the best new depression bloggers I’ve come across in quite some time, Amy McDowell Marlow writes, “dear depression, here you are again. uninvited. unwelcome. and, it seems, unavoidable. i knew you were coming back to see me. i felt it in my eyes, as I watched the brightness twinkle away. i felt it in my shoulders, as i started to droop and slouch. i felt it in my steps, as my feet became weighted. depression, i knew.” Read the Blog
Most folks with depression have a complicated relationship with their antidepressant medications.
I certainly do.
If I feel tired and flat on a particular afternoon, is it depression, the side effects of my meds or a jumble of both? Or maybe, it’s just my persistently pensive nature?
I think about this a lot these days – and maybe you do as well.
While the one-two punch of Cymbalta and Lamictal have kept me out of the dungeon of major depression for years, its comes with a cost. I have interludes of passivity, numbness, and fatigue. Maybe a low-grade depression at times, as well. If I ditch the drugs, maybe I will feel more “alive,” I think. I fantasize that cutting my ties with meds could lessen the days lost to the deadening grayness of a medically induced sense of normalcy I sometimes go through.
But I also feel anxiety. If I went cold turkey and lived medication-free, would it end, well, in disaster? A return to the swampland of depression? A deadman’s land if ever there was one. Can I take that chance? Should I?
There’s scary research that suggests once you stop antidepressants that work (or sort-of-work) for you and try to go back on the same ones because being off of them caused your depression to return (or you just couldn’t tolerate the horrible side effects that can come with discontinuation), there’s a good chance they won’t be as effective.
So, what’s a depressed person supposed to do? What should I do?
There are two camps that offer some guidance on this issue. Both have persuasive arguments about why those afflicted should or shouldn’t stay on meds.
The Stay on the Meds Camp
If depression is an “illness,” like diabetes or heart disease, I need these meds to balance out my of whacky neurochemistry. Given my risk factors: a family history of depression (genetics), a crazy childhood with a nutty, abusive and alcoholic father, and a high-pressure job with too much stress, I should stay on the pills.
In his insightful essay in the New York Times, In Defense of Antidepressants, psychiatrist, Peter Kramer, author of the best-selling books, Listening to Prozac and Against Depression, suggest that studies show this: for mild or moderate depression, talk-therapy is as or more effective that medication. But for the Moby Dick sized sucker called Major Depression? Medications are warranted, and, indeed, lifesavers. They help many to function and live productive lives, albeit with a range of mild to more severe side effects.
The Get off the Meds Camp
Some people (including psychiatrists) see meds as the devil’s handiwork: supposed chemical solutions to emotional problems that flat-out don’t work. Many psychiatrists’ (and family doctors who write the overwhelming majority of scripts for these drugs in the U.S.), they maintain, are “pill pushers” who do the bidding of “BigPharma”, a multi-billion dollar industry in this country. Antidepressants aren’t so much a cure as a curse.
Irving Kirsh, Ph.D., author of The Emperor’s New Drugs: Exploding the Antidepressant Myth, writes:
“Putting all [the research] together leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing ‘regular’ placebos to ‘extra-strength’ placebos.”
The remedy from this group? Psychotherapy. They see depression as the result of off-kiltered, negative thinking patterns. The way out of these ruminative, pessimistic thoughts involves working with a therapist who uses, most often, Cognitive Behavioral Therapy, to challenge and encourage patients to replace such thoughts with more realistic and positive ones.
In his book Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You, Richard O’Connor, Ph.D. argues that both therapy and medication are effective, but limited in certain respects. He advocates an additional factor often overlooked in depression recovery: our own habits. Unwittingly we get good at depression. We learn how to hide it, how to work around it. We may even achieve great things, but with constant struggle rather than satisfaction. Relying on these methods to make it through each day, we deprive ourselves of true recovery, of deep joy and healthy emotion.
The book teaches us how to replace depressive patterns with a new and more effective set of skills. We already know how to “do” depression-and we can learn how to undo it.
Some Recent News on the Meds and Therapy Conundum
The New York Times reports that a large, multicenter study by Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.
So what’s a depressed person supposed to do?
I don’t know, really.
We’re in a pickle, aren’t we?
Maybe there’ll be a soon-to-be discovered test that can guide us on precisely what to do. But for now, many of us will stay-the-course and, for better or worse, stick to the “plop, plop, fizz, fix”.
I see myself somewhere in the middle of all this. I’ve never been hospitalized or tried to commit suicide. But I have known depression’s scorching winds, gales that have torn the flesh from my body. I will never forget this pain. It’s scarred me. And I never want to return to it.
If you’re thinking of discontinuing your meds, here’s a great article on how to do it safely.
I welcome your comments about your depression journey with or without medicaton.
by Daniel T. Lukasik
Blogger Carol Richard writes in Esperanza magazine writes about depression relapse: “As solid as mine or anyone’s recovery may be, it doesn’t stop the illness from trying to get out & start taking over our lives again. It’s the nature of chronic health issues – why we can only MANAGE our health, not CONTROL it. Great ideas here. Read the Blog
Jennifer Tazzi writes, “The most recent depression held an element of ‘here we go again.’ When I am depression-free, and despite my best intentions, I’m lulled into a false sense of security about the likelihood of another depression occurring.” Read the Blog
Therese Borchard writes about the bitterness she feels when other depression suffers get a repreive from their symptoms. “There was a small voice inside of me that asked, “Why them?” Read the Blog
Federal Judge Shane Marshall said that when personal and professional stress led to his relapse into depression in June, he initially felt like it was a “failure”. Read the News
Things are going along smoothly and then you suffer a depression relapse. What can you do? Read the Blog
A big risk for anyone who has suffered from depression is the real risk that it can reoccur. Read the News
There are many myths and misconceptions about clinical depression. One of the most tiresome is that depression is just being down in the dumps – in my experience, it’s more like being down in the abyss. Or, that depression is just everyday sadness. Who doesn’t get sad, after all, in today’s crazy world?
But depression isn’t normal sadness – not by a long shot. Everyday sadness – which is part of the human experience for everyone bar none — is usually a reaction to some sort of loss whether in real-time (you just lost your job) or in your mind (you have a sad memory). After some period of time, our ability to adapt kicks in and our emotional world levels off; we regain a sense of emotional balance and are ready to face life challenges.
In contrast, clinical depression is persistent sadness (according to experts, something that last two weeks or more – see a list of other symptoms from the DSM- IV as laid by clicking the link above). This sadness does not go away. We do not adapt. We do not return to an emotional balance without some sort of treatment — whether it’s therapy, medication, life style changes (e.g. a committed exercise regimen) or some combination of all three.
Many folks with depression may also have an absence of the normal range of emotion – particularly the ability to experience joy. There is a flat affect – an emotionally deadening; tears are replaced by simply torment. Our emotional range, if you will, our palette of colorful emotions, is reduced to variations of grey or black. Purples, greens and yellows are simply unable to bloom in depression’s arid soil.
The predominant feeling that all depression sufferers endure, if you could call it a feeling, is unadulterated pain; a sense of darkness that sets up residence in the core of our humanity like a burned out sun that has lost its sense of heat and light.
Some people recover from depression and go into complete remission. For many that fall into this group, their depression is contained by medication, therapy, life style changes and/or some combination of all of these. Depression does not return, thank God.
Others – in my experience many – do not per se recover. They have periods of recovery and episodes of relapse. Or, their depression goes from being Major depression (a truly crippling condition where daily functioning is all but impossible) to Dysthymia (a milder, but more chronic form of depression). The biggest difference between the two is that Dysthymia does not usually incapacitate someone and thoughts of suicide are absent.
Stress can trigger the mercenaries of depression to return during a relapse and assault our mind’s garrisons – – a big problems if you’re a lawyer. Too much stress, too many triggers and a lawyer who had been doing pretty well finds herself or himself falling into the basement of despair. This underscores the importance of learning about the patterns of depression in our lives so as to head it off at the pass.
It’s as if each person’s depression (while sharing some common features – hence the DSM IV) has its own personality, like the classic children’s book Where the Wild Things Are. We must learn read the habits of our depressions because we will then be able to recognize the signs of the trouble brewing inside our heads.
Like a storm seen in the distance from the shore, those who’ve been through a depression can sense the barometric pressure dropping and see the threatening clouds approaching. We may not tell others of this sense of foreboding because we don’t want to concern others, feel that they wouldn’t understand or conclude that they can’t do anything to help anyway.
Other signs begin to appear as the storm moves closer to shore: we don’t have the energy to return calls at the office (our voicemail box becomes digital chunks of impatient clients or opposing counsel calling back for the third time), a fragmentation of our ability to think and concentrate and a strong desire to isolate ourselves and wait – for God knows how long – for the storm to pass.
Just as storms form because of a combination of climatic condition, so too does depression.
For law students, their personality types (often neurotic, perfectionist and overachieving), run head on into the pessimistic thinking style they learn in law school – the buzz saw of learning to “think like a lawyer.” This pessimistic style, finds trouble everywhere it looks. It may make us good lawyers, but often unhappy – and depressed – human beings.
For practicing lawyers, the qualities they took into and learned from law school meet head on with the extraordinary demands of a modern law practice. We’ve come to name those who grew up and fought in World War II “The Greatest Generation.” Perhaps today’s lawyers might be thought of as “The Driven Generation.” Law has become less of a profession and more of a business.
For a lawyer who has goes through a relapse of depression, it’s often befuddling to them why they’re they are going through all this shit again. But regardless of the reason, there you are in the thick of it; the vaporous stink of depression has fallen on you like used up coffee grounds. It seems, most assuredly, unfair. Yet, there it is.
Here are some thoughts about preventing relapse and how to keep you feeling well:
- Learn about how your depression expresses itself. When you start to experience the early warning signs of a depression, talk about with a professional. Read 5 Depression Relapse Triggers to Watch For which should give you some further signs to watch for.
- Watch your thoughts. In myself, I can see a shift from a relatively optimistic outlook to a pessimistic one. I am quicker to judge others and assume the worst about them and their behavior – as well as myself. When not in this space, I am likely to be more forgiving and – I am sure my wife would agree – easier to hang out with! Read, Therapy Better Than Antidepressants at Heading Off New Bout Triggered by Sadness.
- People who relapse are often people who stop taking their medication. They do so because they’ve been taking it for awhile, feel better and decide they just don’t want to take it anymore. This can often have disastrous consequences: a return of depression or even suicide. Beware of this and carefully plan out with a professional how to taper off medication if that’s where you would like to go. Read, What is Depression Relapse and Can It Happen to Me?